Bronchodilators

OBJEKT
IF
• Menerangkan tindakan ubat
bronchodilator.
• Menerangkan kesan
sampingan ubat.
• Menyatakan contoh, dos dan
cara pemberian ubat.
• Menyatakan indikasi dan
kontraindikasi ubat.
• Menyatakan nasihat yang
relevan semasa penggunaan/
pemberian ubat.
 Respiratory diseases
• Chronic bronchitis – radang
saluran pernafasan dan menyebabkan
bengkak.
• Emphysema - dinding alveolar
pecah dan melekat bersama-sama
(mengurangkan kadar pertukaran gas)
• Asthma - bronkiol sempit
menghalang saluran pernafasan
dan cenderung untuk mendapat
sakit lebih teruk..
• COPD (Chronic Obstructive
Pulmonary Disease) – nama
diberikan secara kolektif untuk
emfisema & bronkitis kronik kerana
halangan yang hadir setiap masa.
 Bronchodilators

• is a substance that dilates the 
bronchi and bronchioles,
decreasing resistance in the 
respiratory airway and
increasing airflow to the lungs
 Tindakan
• Menyebabkan otot licin
bronkial relek/rehat
• Melegakan ‘bronchospasm’
akibat:
– Spasm otot licin
– Sekatan kahak yang pekat
– Edema pada lapisan mucosa
 General Indication
• Untuk merawat
– Bronchial asthma
– Chronic bronchitis
– Emphysema
– Pneumonia
– COPD
Jenis-jenis Bronchodilators

A. Sympathomimetics
B. Xantine Derivatives
C. Anticholinergics
D. Corticosteroids
Sympathomimetics
(Adrenoceptor
Stimulant)
 Tindakan
• Bertindak ke atas reseptor
adrenergik.
• Menyebabkan otot licin bronkiol
menjadi relaks dan
mengembang (menjadi besar).
• Ini akan mengurangkan
rintangan terhadap pergerakan
udara dalam salur pernafasan.
 Contoh ubat

• salbutamol (Ventolin)
• terbutaline Sulphate
(Bricanyl)
1. salbutamol (Ventolin)

Cara Pemberian
• Oral (tablets/syrup)
• Inhalation (sedutan aerosol)
• Nebulizers (larutan/ solution)
• IV infusion (drips)
 Indication

• Bronchospasm
• Asthma
• Other reversible airway
obstruction
1(a). salbutamol 2mg tablet
(Ventolin)

Category: B
 Dose
• Peads 2-6 yr:
– 1-2mg tds-qid
• Peads 6-12 yr:
– 2mg tds-qid
• Adult & Peads > 12 yr:
– 2-4mg tds-qid
1(b). salbutamol 2mg/5ml syrup
(Ventolin)
Category: B

Dose
• Peads 2-6 yr:
– 1-2mg tds-qid
• Peads 6-12 yr:
– 2mg tds-qid
1(c). salbutamol 100mcg/dose
Inhalation
(Ventolin)

Category: B
 Dose

• Adult:
– 100-200mcg up to tds-qid
• Peads:
– 100mcg/day
– Increase to 200mcg if
necessary
1(d). salbutamol 0.5%
Inhalation Solution
(Ventolin)

Category: B
 Dose

• Adult:
– 2ml inhaled qid over a peroid
of 3min/ inhalation
1(e). salbutamol 5mg/5ml Inj
(Ventolin)
Category: A*

Dose
• Adult:
– 5mg in 500ml (10mcg/ml) IV
infusion at rate of 10-
45mcg/min
– Increase at intervals of 10 min
2. terbutaline sulphate
(Bricanyl)

Cara Pemberian
• Oral (tablets/syrup)
• Inhalation (powder form)
• Nebulizers (larutan)
• Parenteral: (SC, IM, IV)
 Indication
• Bronchospasm
• Asthma
• Other reversible airway
obstruction
2(a). terbutaline sulphate
2.5mg tablet
(Bricanyl)
Category: B
 Dose
• Adult & Peads > 15 yr:
– 2.5mg bd-tds PO (1-2 weeks)
– Upto 5mg tds
• Peads 7-15 yr:
– 2.5mg bd-tds
• Peads < 7 yr:
– 75mcg/kg tds
2(b). terbutaline sulphate
0.3mg/ml syrup
(Bricanyl)
Category: B

Dose
• Peads:
– 3 yrs: 2.5ml bd-tds PO
– 3-6 yrs: 2.5-5ml bd-tds PO
2(c). terbutaline sulphate
0.5mg/dose inhalation powder
(Bricanyl)
Category: B

Dose
• Adult & peads:
– 1-2 inhalation (puff) repeated
up to tds-qid
2(d). terbutaline sulphate
10mg/ml Inhalation Solution
(Bricanyl)
Category: B

Dose
• Adult :
– 5-10mg bd-qid
 Dose
• Peads up to 3 yr:
– 2mg bd-tds
• Peads 3-6 yr:
– 3mg bd-tds
• Peads 6-8 yr:
– 4mg bd-tds
• Peads > 8 yr:
– 5mg bd-tds
2(e). terbutaline sulphate
0.5mg/ml Inj
(Bricanyl)

Category: B
 Dose
• Adult:
– 250-500mcg up to qid SC, IM,
slow IV
• Peads :
– 10mcg/kg/day SC, IM, slow
IV
– Max: 300mcg/day
 Kesan Sampingan
• Hypertension
• Tachycardia
• Palpitation
• Cardiac Arrhythmias
• Nausea & vomiting
• Restlessness
• Anxiety
• Insomnia
• Headache
• Nervousness (cemas)
• Tremor
• Muscle cramp
• Angioedema
 Contraindication

• Allergic to drugs
• Tachycardia
• Cardiac arrhythmias
• Glaucoma
 Cautious
• Hypertension
• Hypertyroidism
• Diabetes
• Prostatic hyperthropy
• Pregnancy
• Lactation
 Interactions

• Sympathomimetic drugs
– Additive adrenergic effects
• MAOIs (monoamine oxidase
inhibitors)
– Hypertensive crisis
• Β-adrenergic blockers
– Inhibit vasodilation
• Oxytocic drugs (delivery)
– Severe hypertension
• Theophylline
– Increased risk of
cardiotoxicity
 Xantine
Derivatives
 Tindakan

• Menyebabkan otot licin

bronkiol menjadi relaks dan
mengembang (menjadi besar).
• Ini akan mengurangkan
rintangan terhadap
pergerakan udara dalam salur
pernafasan.
 Contoh ubat

• aminophylline
• theophylline (Neulin)
1. Aminophylline 25mg/ml Inj
Category: B

Indication
• Bronchospasm
• Asthma
• Chronic bronchitis
• Emphysema
 Dose
• Adult:
– 250-500mg over 20 mins slow
release (IV infusion)
– Severe asthma: 500mcg/kg/hr IV
infusion
• Peads 6 mo to 9 yr:
– 1mg/kg/hr IV infusion
• Peads 10-16 yr:
– 800mcg/kg/hr IV infusion
2. theophylline (Neulin)

Indication
• Bronchospasm
• Asthma
• Chronic bronchitis
• Emphysema
2(a). theophylline 125mg tablet
(Neulin)
Category: B
 Dose
• Adult:
– 125mg tds-qid PO (after food)
– Increase to 250mg PRN
• Peads 7-12 yrs:
– 62.5-125mg tds-qid PO (after
food)
2(b). theophylline 250mg Long
Acting Tablet
(Neulin SR)

Category: B
 Dose
• Adult:
– 250mg bd
• Peads < 12 yrs:
– Up to 10mg/kg bd
2(c). theophylline 80mg/15ml
Syrup
(Neulin)

Category: B
 Dose
• Adult:
– 25ml qid
• Peads > 2 yrs:
– 1ml/kg qid
 Kesan Sampingan
• Tachycardia
• Palpitation
• Seizure (sawan)
• GI disturbance
• Nausea & vomiting
• Headache
• Restlesness
• Nervousness
• Tremors
• Fever
 Contraindication
• Allergic to drugs
• Peptic ulcer
• Active gastritis
• Rectal/colonic irritation or
infection
• Seizure disorder
• Hyperthyroidism
• Serious arrhythmias
 Cautious
• Elderly > 60 yr
• Cardiac disease
• Hypertension
• CHF
• Liver disease
• Pregnancy
• Lactation
 Interactions
• Sympathomimetic drugs
– Additive CNS &
cardiovascular effects
• Food contain xanthine
(coffee, colas, chocolate)
– Increased risk of Cardiac &
CNS adverse reaction
• Cigarettes, nicotine gum, loop
diuretics, isoniazid & rifampicin
– Decrease effectivenss of
xanthines
• Influenza vaccines, oral
contraceptives, β-adrenergic
blockers, macrolides,
allopurinol
– Increased risk of Xanthine
toxicity
Anticholinergics
 Tindakan

• Menghalang tindakan
acetylcholine ke atas otot licin
bronkiol.
• Menyebabkan otot licin
bronkiol menjadi relaks dan
mengembang (menjadi
besar).
• Ini akan mengurangkan
rintangan terhadap
pergerakan udara dalam salur
pernafasan.
 Contoh ubat

• ipratropium bromide
(Atrovent)
1. ipratropium bromide
(Atrovent)

Indication
• Bronchospasm
• COPD
• Chronic bronchitis
• Emphysema
1(a). ipratropium bromide
20mcg/dose Inhalation
(Atrovent)

Category: B
 Dose
• Adult:
– 20-40mcg tds-qid (1-2 puff tds-
qid)
– Early treatment (up to 80mcg 3-4
doses)
• Peads up to 6 yr:
– 20mcg tds (1 puff tds)
• Peads 6-12 yr:
– 20-40mcg tds (1-2 puff tds)
1(b). ipratropium bromide
0.0125% (125mcg/ml) & 0.025%
(250mcg/ml) Inhalation Solution
(Atrovent)

Category: B
 Dose
• Adult:
– 100-500mcg up to qid
• Peads 3-14 yr:
– 100-500mcg up to tds
 Kesan Sampingan
• Dizziness
• Fatigue
• Insomnia
• Nervousness
• Headache
• Blurred vision
• Dry mouth
• Dryness of oropharynx
• Nausea
• Dyspnea
• Palpitation
• Chest pain
• Rash
 Contraindication

• Allergic to drug
 Cautious

• Glaucoma
• Prostatic hypertrophy
• Cystic fibrosis (lung
and digestive)
 Interactions
• Β-adrenergic blockers &
Xanthines
– Additive bronchodilation
• Cisapride (increase motility
upper GI)
– Loss of cisapride efficacy
• Anti-cholinergic drugs
– Additive anti-cholinergic
Corticosteroids
 Tindakan

• Mengurangkan inflamasi pada

salur pernafasan yang
disebabkan oleh
bronchospasm.
• Dengan ini salur pernafasan
akan menjadi besar dan
mengurangan rintangan
terhadap pergerakan udara.
• Jika digunakan secara
inhalasi, ia memberi kesan
secara topikal keatas paru-
paru tanpa kesan sistemik.
 Contoh ubat

• beclomethasone
dipropionate (Becotide)
• budesonide (Pulmicort)
 1. beclomethasone
dipropionate (Becotide)

Indication
• Asthma
• Rhinitis
1(a). beclomethasone
dipropionate 100mcg/dose
Inhalation
(Becotide)
Category: B
 Dose
• Adult:
– 100mcg tds-qid or 200mcg bd
• Peads > 6 yrs:
– 50-100mcg bd-qid
– < 6 yrs: do not use
1(b). beclomethasone
dipropionate 200mcg/dose
Inhalation
(Beclomet)
Category: A
 Dose

• Adult:
– 1-2 inhalations (puffs) bd
– May increase to 2 inhalations
bd-qid
2. budesonide (Pulmicort)

Indication
• Severe Asthma
2(a). budesonide 1mg/2ml or
500mcg/2ml Nebulising Solution
(Pulmicort)

Category: B
 Dose
• Adult:
– Initial: 1-2 mg bd
• Peads 3mo- 12 yr:
– 500mcg-1mg
• Maintenace:
– ½ of above dose
2(b). budesonide 100mcg/dose
or 200mcg/dose Inhalation
(Pulmicort)

Category: B
 Dose
• Adult:
– 200-1600mcg/day (2-4 divided
dose)
• Peads < 12 yr:
– 200-800mcg/day (2 divided
dose)
 Kesan Sampingan
• Headache
• Throat irritation
• Cough
• Fungal Infections (mouth &
throat)
• Nausea
• Pharyngitis
 Contraindication
• Allergic to drug
 Cautious
• Immuno compromised patient
• Glaucoma
• Kidney & liver disease
• Seizure
• Diabetes
• Tuberculosis
• Pregnancy
• Lactation
 Interactions
• Ketoconazole
– Meningkatkan paras serum
corticosteroids
 Soalan
1. Beri definisi ubat
bronchodilators?
2. Senaraikan jenis serta cara
tindakan dan contoh ubat
bronchodilators?
3. Nyatakan kesan sampingan &
kontraindikasi ubat
bronchodilators?